|
IMPLT STRETTA CATHETER ACCESS 8800
|
Facility
|
OP
|
$4,491.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.75 |
| Max. Negotiated Rate |
$4,266.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,694.60
|
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cigna Commercial |
$3,817.35
|
| Rate for Payer: First Health Commercial |
$4,041.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,041.90
|
| Rate for Payer: GEHA Commercial |
$3,592.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,041.90
|
| Rate for Payer: Humana ChoiceCare |
$1,167.66
|
| Rate for Payer: Multiplan All |
$4,086.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,143.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,041.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,266.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,368.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,952.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,122.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,176.63
|
| Rate for Payer: Zelis Auto |
$1,796.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,245.50
|
|
|
IMPLT STRETTA CATHETER ACCESS 8800
|
Facility
|
IP
|
$4,491.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,796.40 |
| Max. Negotiated Rate |
$4,266.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,592.80
|
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cash Price |
$2,694.60
|
| Rate for Payer: Cigna Commercial |
$3,817.35
|
| Rate for Payer: First Health Commercial |
$4,041.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,041.90
|
| Rate for Payer: GEHA Commercial |
$3,143.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,041.90
|
| Rate for Payer: Multiplan All |
$4,086.81
|
| Rate for Payer: OMNI Networks Commercial |
$3,143.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,041.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,266.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,368.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,176.63
|
| Rate for Payer: Zelis Auto |
$1,796.40
|
|
|
IMPLT SUBSTITUTE BONE GRAFT VITOSS
|
Facility
|
IP
|
$4,434.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.60 |
| Max. Negotiated Rate |
$4,212.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,547.20
|
| Rate for Payer: Cash Price |
$2,660.40
|
| Rate for Payer: Cash Price |
$2,660.40
|
| Rate for Payer: Cigna Commercial |
$3,768.90
|
| Rate for Payer: First Health Commercial |
$3,990.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,990.60
|
| Rate for Payer: GEHA Commercial |
$3,103.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,990.60
|
| Rate for Payer: Multiplan All |
$4,034.94
|
| Rate for Payer: OMNI Networks Commercial |
$3,103.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,990.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,212.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,325.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,123.62
|
| Rate for Payer: Zelis Auto |
$1,773.60
|
|
|
IMPLT SUBSTITUTE BONE GRAFT VITOSS
|
Facility
|
OP
|
$4,434.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.50 |
| Max. Negotiated Rate |
$4,212.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,660.40
|
| Rate for Payer: Cash Price |
$2,660.40
|
| Rate for Payer: Cash Price |
$2,660.40
|
| Rate for Payer: Cigna Commercial |
$3,768.90
|
| Rate for Payer: First Health Commercial |
$3,990.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,990.60
|
| Rate for Payer: GEHA Commercial |
$3,547.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,990.60
|
| Rate for Payer: Humana ChoiceCare |
$1,152.84
|
| Rate for Payer: Multiplan All |
$4,034.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,660.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,103.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,990.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,212.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,325.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,901.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,108.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,123.62
|
| Rate for Payer: Zelis Auto |
$1,773.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,217.00
|
|
|
IMPLT SUBSTITUTE BONE VITOSS
|
Facility
|
OP
|
$6,038.00
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
7006220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,509.50 |
| Max. Negotiated Rate |
$5,736.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,622.80
|
| Rate for Payer: Cash Price |
$3,622.80
|
| Rate for Payer: Cash Price |
$3,622.80
|
| Rate for Payer: Cigna Commercial |
$5,132.30
|
| Rate for Payer: First Health Commercial |
$5,434.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,434.20
|
| Rate for Payer: GEHA Commercial |
$4,830.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,434.20
|
| Rate for Payer: Humana ChoiceCare |
$1,569.88
|
| Rate for Payer: Multiplan All |
$5,494.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,622.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,226.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,434.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,736.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,528.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,313.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,509.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,615.34
|
| Rate for Payer: Zelis Auto |
$2,415.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,019.00
|
|
|
IMPLT SUBSTITUTE BONE VITOSS
|
Facility
|
IP
|
$6,038.00
|
|
|
Service Code
|
CPT C9359
|
| Hospital Charge Code |
7006220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.20 |
| Max. Negotiated Rate |
$5,736.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,830.40
|
| Rate for Payer: Cash Price |
$3,622.80
|
| Rate for Payer: Cash Price |
$3,622.80
|
| Rate for Payer: Cigna Commercial |
$5,132.30
|
| Rate for Payer: First Health Commercial |
$5,434.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,434.20
|
| Rate for Payer: GEHA Commercial |
$4,226.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,434.20
|
| Rate for Payer: Multiplan All |
$5,494.58
|
| Rate for Payer: OMNI Networks Commercial |
$4,226.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,434.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,736.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,528.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,615.34
|
| Rate for Payer: Zelis Auto |
$2,415.20
|
|
|
IMPLT SUBSTITUTE BONE VITOSS BA2X
|
Facility
|
OP
|
$12,123.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,030.75 |
| Max. Negotiated Rate |
$11,516.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,273.80
|
| Rate for Payer: Cash Price |
$7,273.80
|
| Rate for Payer: Cash Price |
$7,273.80
|
| Rate for Payer: Cigna Commercial |
$10,304.55
|
| Rate for Payer: First Health Commercial |
$10,910.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,910.70
|
| Rate for Payer: GEHA Commercial |
$9,698.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,910.70
|
| Rate for Payer: Humana ChoiceCare |
$3,151.98
|
| Rate for Payer: Multiplan All |
$11,031.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,273.80
|
| Rate for Payer: OMNI Networks Commercial |
$8,486.10
|
| Rate for Payer: One Health Plan PPO/POS |
$10,910.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,516.85
|
| Rate for Payer: Three Rivers Provider Network All |
$9,092.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,668.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,030.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,274.39
|
| Rate for Payer: Zelis Auto |
$4,849.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,061.50
|
|
|
IMPLT SUBSTITUTE BONE VITOSS BA2X
|
Facility
|
IP
|
$12,123.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,849.20 |
| Max. Negotiated Rate |
$11,516.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,698.40
|
| Rate for Payer: Cash Price |
$7,273.80
|
| Rate for Payer: Cash Price |
$7,273.80
|
| Rate for Payer: Cigna Commercial |
$10,304.55
|
| Rate for Payer: First Health Commercial |
$10,910.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,910.70
|
| Rate for Payer: GEHA Commercial |
$8,486.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,910.70
|
| Rate for Payer: Multiplan All |
$11,031.93
|
| Rate for Payer: OMNI Networks Commercial |
$8,486.10
|
| Rate for Payer: One Health Plan PPO/POS |
$10,910.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,516.85
|
| Rate for Payer: Three Rivers Provider Network All |
$9,092.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11,274.39
|
| Rate for Payer: Zelis Auto |
$4,849.20
|
|
|
IMPLT SUTURE ANCHOR 3.5 #2
|
Facility
|
IP
|
$1,127.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$1,070.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$901.60
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cigna Commercial |
$957.95
|
| Rate for Payer: First Health Commercial |
$1,014.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,014.30
|
| Rate for Payer: GEHA Commercial |
$788.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,014.30
|
| Rate for Payer: Multiplan All |
$1,025.57
|
| Rate for Payer: OMNI Networks Commercial |
$788.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,014.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,070.65
|
| Rate for Payer: Three Rivers Provider Network All |
$845.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,048.11
|
| Rate for Payer: Zelis Auto |
$450.80
|
|
|
IMPLT SUTURE ANCHOR 3.5 #2
|
Facility
|
OP
|
$1,127.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$1,070.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cigna Commercial |
$957.95
|
| Rate for Payer: First Health Commercial |
$1,014.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,014.30
|
| Rate for Payer: GEHA Commercial |
$901.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,014.30
|
| Rate for Payer: Humana ChoiceCare |
$293.02
|
| Rate for Payer: Multiplan All |
$1,025.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$676.20
|
| Rate for Payer: OMNI Networks Commercial |
$788.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,014.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,070.65
|
| Rate for Payer: Three Rivers Provider Network All |
$845.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$991.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$281.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,048.11
|
| Rate for Payer: Zelis Auto |
$450.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$563.50
|
|
|
IMPLT SUTURE ANCHOR 3.5MM
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.20
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$902.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
|
|
IMPLT SUTURE ANCHOR 3.5MM
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$1,031.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Humana ChoiceCare |
$335.14
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.40
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,134.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.50
|
|
|
IMPLT SUTURE ANCHOR 5.5 # 2
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.25 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$1,031.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Humana ChoiceCare |
$335.14
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$773.40
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,134.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$322.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$644.50
|
|
|
IMPLT SUTURE ANCHOR 5.5 # 2
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.20
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$902.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
|
|
IMPLT SUTURE SPIRAL STRTFX
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.75 |
| Max. Negotiated Rate |
$2,567.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,621.80
|
| Rate for Payer: Cash Price |
$1,621.80
|
| Rate for Payer: Cash Price |
$1,621.80
|
| Rate for Payer: Cigna Commercial |
$2,297.55
|
| Rate for Payer: First Health Commercial |
$2,432.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,432.70
|
| Rate for Payer: GEHA Commercial |
$2,162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,432.70
|
| Rate for Payer: Humana ChoiceCare |
$702.78
|
| Rate for Payer: Multiplan All |
$2,459.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,621.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,892.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,432.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,567.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,027.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,378.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$675.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,513.79
|
| Rate for Payer: Zelis Auto |
$1,081.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,351.50
|
|
|
IMPLT SUTURE SPIRAL STRTFX
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7002915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.20 |
| Max. Negotiated Rate |
$2,567.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,162.40
|
| Rate for Payer: Cash Price |
$1,621.80
|
| Rate for Payer: Cash Price |
$1,621.80
|
| Rate for Payer: Cigna Commercial |
$2,297.55
|
| Rate for Payer: First Health Commercial |
$2,432.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,432.70
|
| Rate for Payer: GEHA Commercial |
$1,892.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,432.70
|
| Rate for Payer: Multiplan All |
$2,459.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,892.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,432.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,567.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,027.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,513.79
|
| Rate for Payer: Zelis Auto |
$1,081.20
|
|
|
IMPLT SUTURE STRATAFIX 2-0 SPIRAL CT
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$58.76
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$135.60
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$198.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$56.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.00
|
|
|
IMPLT SUTURE STRATAFIX 2-0 SPIRAL CT
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.80
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
|
|
IMPLT SUTURE STRATAFIX CLEAR SH-1
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$56.68
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.80
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$191.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.00
|
|
|
IMPLT SUTURE STRATAFIX CLEAR SH-1
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.40
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
|
|
IMPLT SYSTEM BIOCOMPOSITE MPFL
|
Facility
|
IP
|
$7,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,892.80 |
| Max. Negotiated Rate |
$6,870.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,785.60
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cigna Commercial |
$6,147.20
|
| Rate for Payer: First Health Commercial |
$6,508.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,508.80
|
| Rate for Payer: GEHA Commercial |
$5,062.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,508.80
|
| Rate for Payer: Multiplan All |
$6,581.12
|
| Rate for Payer: OMNI Networks Commercial |
$5,062.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,508.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,870.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,424.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,725.76
|
| Rate for Payer: Zelis Auto |
$2,892.80
|
|
|
IMPLT SYSTEM BIOCOMPOSITE MPFL
|
Facility
|
OP
|
$7,232.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,808.00 |
| Max. Negotiated Rate |
$6,870.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,339.20
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cigna Commercial |
$6,147.20
|
| Rate for Payer: First Health Commercial |
$6,508.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,508.80
|
| Rate for Payer: GEHA Commercial |
$5,785.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,508.80
|
| Rate for Payer: Humana ChoiceCare |
$1,880.32
|
| Rate for Payer: Multiplan All |
$6,581.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,339.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,062.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,508.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,870.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,424.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,364.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,808.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,725.76
|
| Rate for Payer: Zelis Auto |
$2,892.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,616.00
|
|
|
IMPLT SYSTEM ELBOW IMPLANT TOGGLELOC
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$463.20
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$405.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
|
|
IMPLT SYSTEM ELBOW IMPLANT TOGGLELOC
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Humana ChoiceCare |
$150.54
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$347.40
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$509.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$289.50
|
|
|
IMPLT SYSTEM HIP MOD REST 19MM +10 V40
|
Facility
|
IP
|
$11,699.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,679.60 |
| Max. Negotiated Rate |
$11,114.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,359.20
|
| Rate for Payer: Cash Price |
$7,019.40
|
| Rate for Payer: Cash Price |
$7,019.40
|
| Rate for Payer: Cigna Commercial |
$9,944.15
|
| Rate for Payer: First Health Commercial |
$10,529.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,529.10
|
| Rate for Payer: GEHA Commercial |
$8,189.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,529.10
|
| Rate for Payer: Multiplan All |
$10,646.09
|
| Rate for Payer: OMNI Networks Commercial |
$8,189.30
|
| Rate for Payer: One Health Plan PPO/POS |
$10,529.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11,114.05
|
| Rate for Payer: Three Rivers Provider Network All |
$8,774.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,880.07
|
| Rate for Payer: Zelis Auto |
$4,679.60
|
|
